Kumar Ranjith M, Saini Lokesh, Kaushik Jaya Shankar, Chakrabarty Biswaroop, Kumar Atin, Gulati Sheffali
Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India.
J Trop Pediatr. 2015 Oct;61(5):393-6. doi: 10.1093/tropej/fmv036. Epub 2015 Jul 1.
Moyamoya vasculopathy, arising secondary to tubercular meningitis (TBM) is unusual. There have also been a few reports of cerebral venous sinus thrombosis (CVST) in TBM. A case of TBM, complicated simultaneously by Moyamoya syndrome and CVST, is being presented here.
A 1-year-old girl presented with febrile encephalopathy, vomiting, seizures and left hemiparesis. Cerebrospinal fluid analysis was suggestive of TBM. Extensive infarcts were noted in the magnetic resonance imaging, involving right middle cerebral artery (MCA), anterior cerebral artery and the left MCA. Magnetic resonance venogram revealed left transverse venous sinus thrombosis and magnetic resonance angiography showed bilateral moyamoya pattern of arteriopathy. Patient was started on antitubercular therapy and low molecular weight heparin.
Early vascular involvement affecting both arterial and venous structures has not hitherto been reported in CNS tuberculosis. Early recognition of secondary complications of CNS tuberculosis is crucial to prevent the morbidity and mortality associated with TBM.
继发于结核性脑膜炎（TBM）的烟雾病样血管病变并不常见。也有一些关于TBM合并脑静脉窦血栓形成（CVST）的报道。本文报告一例同时并发烟雾病综合征和CVST的TBM病例。
一名1岁女孩出现发热性脑病、呕吐、癫痫发作和左侧偏瘫。脑脊液分析提示为TBM。磁共振成像显示广泛梗死，累及右侧大脑中动脉（MCA）、大脑前动脉和左侧MCA。磁共振静脉造影显示左侧横窦血栓形成，磁共振血管造影显示双侧烟雾病样动脉病变。患者开始接受抗结核治疗和低分子量肝素治疗。
中枢神经系统结核迄今尚未报道早期血管受累同时影响动脉和静脉结构。早期识别中枢神经系统结核的继发并发症对于预防与TBM相关的发病率和死亡率至关重要。
